Reopening of California Justified by Lower Total of COVID-19 Deaths

In the nearly three and a half months since California Gov. Gavin Newsom declared a state of emergency March 4, state and county officials have imposed severe lockdowns throughout the state in response to the coronavirus pandemic.

Newsom’s declaration gave essentially unlimited powers to health officers, at both the state level and the county level, to control the virus. Those unprecedented public health powers have been used for the first time in American history to require Californians to stay at home and to completely shut down schools and businesses.

Those orders have had devastating economic and social consequences throughout the state.

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On April 12, Dr. Jeffrey Klausner and I made the case that California’s coronavirus policy must be based on all relevant data and must be publicly justified. On April 23, I made the case that coronavirus policy must consider total mortality as a way of determining its overall health impact. 

The March 18 designation of the World Health Organization’s International Classification of Diseases (ICD-10) diagnosis code for COVID-19, U07.1, has led to inconsistencies in assigning the underlying cause for deaths related to COVID-19. However, it has been very difficult to obtain the justification for the lockdowns and recent mortality data. 

The California Health and Human Services Agency initially rejected two detailed May 13 Public Records Act requests, but on June 11, the agency produced some relevant documents, including monthly California deaths from 2015 to 2020.

To properly assess the mortality risk associated with the coronavirus pandemic, it is necessary to examine deaths and death rates from all causes, not just deaths and death rates from COVID-19.

Weekly COVID-19 and total death data during 2020 is available from the Centers for Disease Control’s National Center for Health Statistics. During January-May 2020, the CDC and Department of Health and Human Services show about 120,000 total deaths in California, which is similar to the number during January-May 2018. 

Thus, the 2020 total death rates in California can be approximated by the 2018 total death rates, which are in the CDC’s WONDER database. I focus here on those under 65 years of age because they include students and most working-age people, and because COVID-19 deaths comprise only 3% of the total deaths in this age range during 2020.

For each of the following geographically defined groups, the approximate annual age-adjusted total death rate for persons ages 0-64 years, in deaths per thousand persons, is: 

Santa Clara County                               1.17

California Hispanics                             1.58

Los Angeles County                              1.70

California (lowest state rate)             1.76

United States (average)                       2.30

Eight Southern states                          3.10 to 3.65

Santa Clara County may have the lowest death rate of any sizable U.S. county.  Los Angeles County also has a low death rate.

The low death rate among California Hispanics is consistent with the phenomenon that Hispanics have lower than average total death rates, known as the “Hispanic Paradox.” California has a death rate that’s lower than the rates in all the other states and far lower than the rates in eight Southern states that are well into reopening.  

These low California total death rates are a reflection of the overall healthiness of Californians, a phenomenon that has existed for many years. This healthiness may be contributing to the fact that the California COVID-19 death rate is only one-third of the U.S. COVID-19 death rate.

In addition, the CDC’s “current best estimate” is a 0.40% fatality rate among symptomatic coronavirus cases, which is roughly equivalent to a 0.26% fatality rate among all infected cases and a 0.10% fatality rate among infected cases outside of nursing homes.

These infection fatality rates are remarkably low and are similar to the fatality rate for the seasonal flu.  

California is a low-risk state for both COVID-19 deaths and total deaths. The 85% of Californians who are under 65 years of age are at very low risk for COVID-19, and those without underlying health conditions have essentially no risk.

These Californians must be allowed to return to school, work, and normal activities as soon as possible. A return to normal can certainly be done in a way that minimizes coronavirus risk, restores economic activity, minimizes social disruption, and restores constitutional rights. 

Older Californians and those at high risk for COVID-19 can continue to be sheltered and monitored.

My colleagues, Dr. Klausner and Dr. Rajiv Bhatia, have made a compelling case for ending the March 3 emergency order, and most of California is now in various stages of reopening.  Indeed, even Los Angeles County is on its way to reopening. 

The very strict May 13 “Safer at Home Order,” which was originally projected to last into August, has already been modified several times.  It’s now replaced with the June 11 “Safer at Work Order.” However, Santa Clara County continues to enforce a very strict June 5 “Shelter in Place Order.”

California can best deal with the coronavirus pandemic by basing its public health orders on a balanced and transparent assessment of all the relevant health, economic, and social evidence, including accepting input from all qualified experts in California.

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